The VALUE of Medical Physicists at a Community Medical Center

Transcription

1 D D d The VALUE of Medical Physicists at a Community Medical Center Without medical physicists this place could not function properly (Yes, we re crazy) Jeremy Donaghue Jeremy.donaghue@akrongeneral.org

2 Outline Physical Presence/Credentials General Knowledge Teaching IS Technology Beta Testing AGHS Specifics

3 Physical Presence/Credentials The Ohio Department of Health requires all radiation therapy locations to have a Certified Radiation Expert in Therapy (CRE). Brachytherapy High Dose Rate Low Dose Rate Stereotactic Procedures (SRS/SBRT) Gamma Knife Radiation Safety/QA meetings

4 General Knowledge Radiation Therapist Dosimetrist Simulation Technologist Lean staffing has made this more important.

5 Teaching New process New equipment/technology - Yes, there are trainers, but not everyone is always available. - Sometimes adjustments need to be made for clinical flow Refresher on a treatment technique not used that often Staff just forgot how to do something I read this paper about this different treatment technique for this. Can we try/do this? Patient should start treatment early next week.

6 IS My (software name) is not working My (computer hardware) is not working IS unable to install standard software I deleted the (MOSAIQ) shortcut I need an account Learn to program

7 Technology Need to be aware of what s new and coming out (ahead enough so that it can be budgeted appropriately) Look into new companies and find possible novel concepts Be prepared in case administration asks questions about possible new technology Investigate possible equipment that the facility is looking into

8 Beta Testing If not too time consuming, it s a good thing. Gives you the ability to have some direct input into the product.

9 QA! Lots of TG s to follow (plus ODH regs) Parallel Imaging in MRI: Technology, Applications, and QC Dosimetric effects caused by couch tops and immobilization devices

10 Statistical Process Control Operating with Minimum Variance is achieved only when a process displays a reasonable degree of statistical control. Both of these concepts are revolutionary. Walter A. Shewhart

11 AGHS Specific Treatment Plan Checks Automated Monitoring No Fly Policy Daily Team Huddle New/Different Equipment Bonus

12 Treatment Plan Checks Automated - All items transferred appropriately - Prescription matches treatment plan - All beam parameters (all photon beams) - Site Setup Parameters Isocenter Patient Positioning Shifts (soon) - Is there a TPS generated bolus Expected treatment table coordinates exported (local+tx) - Which indexing should work - Possible table collisions (T=0) Automation allows for more thorough plan checks

13 Isocenter Checks All isocenters are coincident. MOSAIQ and RayStation isocenters match Orientation Verification RayStation and planning exam orientation match MOSAIQ and Raystation Orientation Check Left Breast PASS BeamSet Checks Beam Set: Left Breast BOLUS CHECK Beam Name Present? 1 G46C188T170 No 2 G66C188T170 No 3 G213C172T170 No 4 G233C172T170 No PRESCRIPTION CHECK Prescription Name: Pass Fractions: Pass Total Dose: Pass Type: Pass Percentage: Pass

14 Total Processing Time: seconds

15 Automated Monitoring Daily QA - Recorded - Outputs ok Patient Treatment - Isocenter change in Site Setup - Patients due soon/today/tomorrow No Fly policy has reduced - Special Procedures tomorrow

16 No Fly Change from reactive to proactive Must have a full day of all the new start work done prior to the start of treatment. (exception for IMRT QA if scheduled) Even though our patient load is up, this has actually given us more time as a staff. Articles (North Shore-Long Island Jewish Health System) - Kapur A, Potters L, Six- sigma tools for a patient safety oriented, quality- checklist driven radiation medicine department, Journal of Practical Radiation Oncology (in press), Potters L, Kapur A, Implementation of a no fly safety culture in a multicenter radiation medicine department, Journal of Practical Radiation Oncology (in press), 2011

17 Daily Team Huddle Includes: - Physicists - Dosimetrists - Therapists (1 per machine is the goal) Used to discuss what s going on - New plans coming out -> start date - Issues that can prevent start dates - Any issues that need resolved

18 New/Different Equipment RayStation - Better tool for dosimetrists CYRPA Lasers - Auto calibration of lasers C- Rad (Surface tracking) Looking into MRI simulation equipment

19 Family Open time is created on the treatment machines for special procedures No special procedures=qa time

20 Uniform

21 Why are we doing this? (Besides it makes life easier) Preparation for adaptive treatments What didn t I address to make this possible/rapid? - QA

22 Adaptive QA Considerations Slightly more thorough MLC QA program - Track daily that dynalog/tracking information matches reality. (EPID imaging) How to get around IMRT QA? - We ve verified that everything transferred appropriately/ accurately - Secondary, calculation check with fully commissioned TPS equivalent system. (Mobius/Compass) - Dose reconstruction algorithm on CBCT (?) - Track delivered plan was delivered appropriately

23 Enjoy Work